Pediatric keratoconus epidemiology: a systematic scoping review.

BACKGROUND: Pediatric keratoconus (pediatric KC) causes progressive deformation of the cornea in children and adolescents, leading to a gradual loss of vision and a need for rehabilitation. However, new treatments may halt the disease and prevent worse outcomes that require penetrating keratoplasty and its associated morbidity and high cost, irreversible loss of vision, and amblyopia. Few systematic reviews focus on keratoconus-and even fewer, on pediatric KC. METHODS: Here, we report a systematic scoping review of pediatric KC epidemiology and discuss the studies reporting data on pediatric KC. We used PRISMA-ScR methodology and checklists in the elaboration of the manuscript. The inclusion criteria were: English language; publication between August 7, 1998, and August 7, 2019 (20 years); theme of the study pediatric KC epidemiology. The search strategy: searches of the PubMed-MEDLINE database and Cochrane Database of Systematic Reviews, using eight combinations of the following MeSH terms: keratoconus; child; incidence; prevalence; pediatrics; adolescent; epidemiology. RESULTS: We charted and reviewed the selected articles. Initial searches included 1802 records; after the exclusion of article duplicates, we screened 777 records, read 97 articles in full text, and included 76 articles in this review. CONCLUSIONS: Recent epidemiological studies with better methodologies demonstrated increased prevalence rates in comparison to the older literature. This effect may be due to better diagnostic methods and better sample selection than those in historical studies. Diagnosis remains a major challenge as the early disease is usually asymptomatic. Economic and social aspects of pediatric KC remain understudied in the pediatric literature. Global, inclusive, and proactive screening studies in schools are imperative to better understand the great impact of this disease in the young.

Preoperative Predictors for Acute Pain After Photorefractive Keratectomy.

PURPOSE: The aim of this study was to identify preoperative predictors for the occurrence of early severe postoperative pain in patients undergoing photorefractive keratectomy (PRK). The implementation of preoperative screening methods may facilitate more specific or aggressive pain therapies specifically targeted to individuals at a high risk of experiencing severe postoperative pain. METHODS: This was exploratory research that included patients who underwent PRK. Before PRK, patients were administered a sociodemographic questionnaire, the Pain Catastrophizing Scale, and the State-Trait Anxiety Inventory and underwent corneal sensitivity and conditioned pain modulation (CPM) tests. Post-PRK pain was assessed using a pain intensity visual analog scale (VAS), and the short-form McGill Pain Questionnaire (SF-MPQ) was completed 21 days before PRK and 1, 24, 48, and 72 hours after PRK. Spearman correlations were calculated for pain scores and preoperative predictors. RESULTS: This research included 34 eyes of 34 patients. Preoperative corneal sensitivity was positively correlated with post-PRK pain scores as assessed by VAS and SF-MPQ (rho = 0.39 and rho = 0.41, respectively, P < 0.05). No correlations were found between Pain Catastrophizing Scale, State-Trait Anxiety Inventory, and CPM scores and post-PRK pain scores ( P > 0.05). CONCLUSIONS: Abnormal presurgical corneal sensitivity was a protective marker for severe pain after PRK, while scores as assessed by VAS and SF-MPQ and CPM were not related to postoperative pain.

Peripampasic Arc: a route of dispersion for lichens.

The Peripampasic Arc is a set of low mountains / hills that connects the Andes, as it scatters to the East forming mountainous areas of lower heights in north-eastern Argentina, with the Atlantic coastal range of the Serra do Mar in Brazil. Numerous studies proved its important biogeographic connection for plant and animal phylogenies, but no information of this pattern is known to lichens. The aim of this work is to establish if the dispersion route of the lichenbiota follows the previously known Peripampasic Arc. For this reason, a comparative study of each area regarding its similarities was analyzed, with emphasis on the biota of the Buenos Aires' Sierras. We quantified the similarity and ß diversity of 104 saxicolous lichens species. There was a strong similarity between the Sierra de la Ventana and Tandil biota, which in turn is linked to the biotas of Uruguay, the Pampean Sierras and the northwest of Argentina. The lack of subgroups in the Peripampasic Arc implies the arc acts as a functional unit of dispersion, which is the most likely cause for the present lichens' distribution.

Different Cooling Strategies Applied During Inter-Set Rest Intervals in High-Intensity Resistance Training.

The purpose of this study was to verify whether cooling between sets during high-intensity resistance exercise improves physical performance and to compare performance among different sites of cooling. It is important because delaying the muscular fatigue could improve total volume at a training session which could lead to greater hypertrophy. Nine healthy and recreational resistance training experienced men, performed six tests of a biceps curl exercise on different days. The first test was the one-repetition maximum test (1RM). Following, we applied five sessions, in crossover and randomized (counter-balanced) design. The subjects received different cooling strategies in each session for 1-min (inter-set rest interval): Control (C) (no Cooling); Palm Cooling (PC); Neck Cooling (NC); Local Cooling (LC) or Tunnel Temperature Cooling (TTC). We analyzed the maximum number of repetitions and the rating of perceived exertion (RPE). The Bayesian analysis showed that no cooling strategy was able to improve performance compared to control, and just NC, when compared to control, showed a 71% probability of increasing the total volume of repetitions. Also, RPE was not modulated by any cooling strategy compared to control, but NC has a chance to reduce individuals' RPE by 52%. In conclusion, no cooling strategy was efficient to improve physical performance during a high-intensity resistance exercise.

Codeine plus acetaminophen improve sleep quality, daily activity level, and food intake in the early postoperative period after photorefractive keratectomy: a secondary analysis.

PURPOSE: To determine whether codeine plus acetaminophen after photorefractive keratectomy (PRK) have beneficial effects on sleep quality, activity levels, and food intake, beyond their effect of pain relief. METHODS: We enrolled 40 patients (80 eyes) in this randomized, double-blind, paired-eye, placebo-controlled, add-on trial. Each eye was treated 2 weeks apart, and the patients were randomly allocated to receive either the placebo or the intervention (30 mg codeine and 500 mg acetaminophen) (4 times a day for 4 days). Outcomes were sleep quality, daily activity level, and food intake within 24-72 h post-photorefractive keratectomy, as measured by the McGill Pain Questionnaire. RESULTS: Sleep quality and daily activity level were inversely associated with pain scores within the first 48 h post-photorefractive keratectomy. During the intervention, patients were significantly more likely to score their sleep quality as good at 24 h (relative risk=2.5; 95% confidence interval 1.48-4.21, p<0.001) and 48 h compared to during placebo (relative risk=1.37; 95% confidence interval: 1.03-1.84, p=0.023). The probability of reporting good daily activity level at 24 and 72 hours post-photorefractive keratectomy was three times higher when patients received the intervention compared to the placebo (relative risk=3.0; 95% confidence interval: 1.49-6.15, p=0.006 and relative risk=1.31; 95% confidence interval: 1.02-1.67, p=0.021, respectively). No difference was observed in food intake. CONCLUSION: The oral combination of codeine and acetaminophen significantly improves sleep quality and daily activity level within the first 24-72 h post-photorefractive keratectomy compared to a placebo.

Codeine plus acetaminophen improve sleep quality, daily activity level, and food intake in the early postoperative period after photorefractive keratectomy: a secondary analysis / Melhora da qualidade do sono e das atividades diárias pós PRK imediato utilizando codeína com paracetamol: análise secundária de um ensaio clínico randomizado, duplo-cego e placebo-controlado

ABSTRACT Purpose: To determine whether codeine plus acetaminophen after photorefractive keratectomy (PRK) have beneficial effects on sleep quality, activity levels, and food intake, beyond their effect of pain relief. Methods: We enrolled 40 patients (80 eyes) in this randomized, double-blind, paired-eye, placebo-controlled, add-on trial. Each eye was treated 2 weeks apart, and the patients were randomly allocated to receive either the placebo or the intervention (30 mg codeine and 500 mg acetaminophen) (4 times a day for 4 days). Outcomes were sleep quality, daily activity level, and food intake within 24-72 h post-photorefractive keratectomy, as measured by the McGill Pain Questionnaire. Results: Sleep quality and daily activity level were inversely associated with pain scores within the first 48 h post-photorefractive keratectomy. During the intervention, patients were significantly more likely to score their sleep quality as good at 24 h (relative risk=2.5; 95% confidence interval 1.48-4.21, p<0.001) and 48 h compared to during placebo (relative risk=1.37; 95% confidence interval: 1.03-1.84, p=0.023). The probability of reporting good daily activity level at 24 and 72 hours post-photorefractive keratectomy was three times higher when patients received the intervention compared to the placebo (relative risk=3.0; 95% confidence interval: 1.49-6.15, p=0.006 and relative risk=1.31; 95% confidence interval: 1.02-1.67, p=0.021, respectively). No difference was observed in food intake. Conclusion: The oral combination of codeine and acetaminophen significantly improves sleep quality and daily activity level within the first 24-72 h post-photorefractive keratectomy compared to a placebo.

RESUMO Objetivo: Determinar se codeína (30 mg) mais pa­racetamol (500 mg) após ceratectomia fotorrefrativa fornece efeitos benéficos sobre a qualidade do sono, níveis de atividade e ingestão de alimentos além de seu efeito analgésico. Métodos: Quarenta pacientes (80 olhos) foram incluídos neste estudo randomizado, duplo-cego, pareado, placebo-controlado, add-on. Cada olho foi tratado com 2 semanas de intervalo, sendo aleatoriamente alocado para placebo ou intervenção (4x/dia durante 4 dias). Os resultados incluíram a qualidade do sono, atividade diária e ingestão de alimentos dentro de 24-72 horas de pós-operatório, conforme medido pelo McGill Pain Questionnaire. Resultados: A qualidade do sono e os níveis de atividade foram inversamente associados aos escores de dor nas primeiras 48 horas após o ceratectomia fotorrefrativa. Durante a intervenção, os pacientes foram significativamente mais propensos a classificar seu sono como bom em 24 horas (risco relativo=2,5, intervalo de confiança de 95%: 1,48-4,21, p<0,001) e 48 horas comparado ao placebo (risco relativo=1,37, intervalo de confiança de 95%: 1,03-1,84, p=0,023). A probabilidade de relatar bons níveis de atividade em 24 e 72 horas após ceratectomia fotorrefrativa também foi significativamente maior durante a intervenção em comparação com placebo (risco relativo=3,0, intervalo de confiança de 95%: 1,49-6,15, p=0,006 e risco relativo=1,31, intervalo de confiança de 95%: 1,02 -1,67, p=0,021, respectivamente). Nenhuma diferença foi observada entre a intervenção e placebo em relação à alimentação oral. Conclusão: A combinação de codeína e paracetamol melhorou significativamente a qualidade do sono e atividades diárias nas primeiras 24-72 horas após o ceratectomia fotorrefrativa em comparação com placebo.

Effects of photobiomodulation on muscle strength in post-menopausal women submitted to a resistance training program.

The aim of this study was to compare the effects of resistance training of low volume and high intensity with or without photobiomodulation (PBM) on muscle strength and functional performance in post-menopausal women. Thirty-four post-menopausal women were randomized into resistance training (RTG, n = 17) or resistance training plus PBM (PBMG, n = 17). Individuals from both groups received the same RT protocol consisting of leg-press 45°, front lat pulldown, leg curl, chest press, and squat performed in two sets of 10 repetitions with a workload of 75% of one repetition maximum (1RM), twice per week, during 8 weeks. PBMG individuals also received, prior to the exercise session, PBM through a cluster containing 7 visible diodes (630 nm) and 7 infrared diodes (850 nm) with power of 100 mW each and energy of 4 J per diode, applied to the quadriceps femoris muscle; individuals from RTG received placebo PBM prior to the sessions, applied with the same device switched off. Muscle strength (1RM; isometric dynamometer), functional performance (Time Up and Go; Berg Balance Scale; 6-min walk test), and quality of life (World Health Organization Quality of Life-Bref) were performed before and after 8 weeks. Both groups increased muscle strength (p < 0.001) for all exercises, without group differences (p = 0.651). Quality of life (p = 0.015) and balance (p = 0.006) increased only in the RTG. The results suggest that PBM were not able for inducing additional benefits to RT to improve muscle strength in post-menopausal women.

Manejo del dolor en el postoperatorio de cirugías articulares. Nuevos enfoques / Pain management in joint surgeries postoperative period. New approache

Introducción: el manejo del dolor junto con la reducción del estrés preoperatorio y la pronta rehabilitación, reducen a su vez la morbimortalidad postoperatoria y establecen la base del manejo presente del paciente quirúrgico. Objetivo: revisar los más recientes enfoques en el manejo del dolor en el postoperatorio de cirugías articulares. Desarrollo: la cirugía de grandes articulaciones como, por ejemplo, la artroplastia total de rodilla, se encuentra relacionada con dolor postoperatorio que se describe como intenso, pues hasta el 50 por ciento de los casos necesitan el empleo de opioides u otros fármacos analgésicos para dominarlo de manera eficaz. Conclusiones: aunque la efectividad analgésica post-operatoria de ciertos fármacos, agregados al anestésico local en anestesia espinal, ha sido investigada en reemplazos articulares. Todavía no se ha determinado el verdadero rol de los fármacos coadyuvantes y las terapias no farmacológicas, y es necesario en un futuro una guía práctica centrada en la evidencia clínica para cada proceso, que circunscriba a la rehabilitación postquirúrgica(AU)

Introduction: the management of pain together with the reduction of preoperative stress and early rehabilitation, in turn reduce postoperative morbidity and mortality and establish the basis of the current management of the surgical patient. Objective: to review the most recent pain management related approaches in the postoperative period of joint surgeries. Development: the surgery of large joints, such as total knee arthroplasty, is related to postoperative pain that is described as intense, since up to 50 percent of cases require the use of opioids or other analgesic drugs to control it effectively. Conclusions: although the postoperative analgesic effectiveness of certain drugs, added to local anesthetics in spinal anesthesia, has been investigated in joint replacements, the true role of adjuvant drugs and non-pharmacological therapies has not yet been determined, and a practical guide focusing on the clinical evidence for each process, which circumscribes post-surgical rehabilitation, is necessary in the future(AU)

Observations of the development of Xanthoparmelia farinosa under optical and electron microscopy.

Xanthoparmelia farinosa is a foliose lichen widely distributed in South America, growing not only on rocks but also on man-made structures. This species has abundant soralia, but it is unknown how development occurs from the soredium to the formation of a complete thallus. The soredia were extracted from the thallus with forceps, planted on glass plates and exposed to outdoor conditions for a period of 24 months; in every 3 months, optical inspection was performed with a stereomicroscope and a compound microscope, in addition, four samples with different exposure times were chosen to observe under a scanning electron microscope. The development of hyphae and the adhesion of these to the substrate, and the outlines of the formation of the lobules and rhizines could be observed. Our study is a first attempt to understand the development of this species which is endemic to South America and very common in the area.

Codeine Plus Acetaminophen for Pain After Photorefractive Keratectomy: A Randomized, Double-Blind, Placebo-Controlled Add-On Trial.

BACKGROUND: Pain after photorefractive keratectomy (PRK) is significant, and the analgesic efficacy and safety of oral opioids in combination with acetaminophen has not been fully investigated in PRK trials. PURPOSE: To assess the efficacy and safety of the combination of codeine plus acetaminophen (paracetamol) versus placebo as an add-on therapy for pain control after PRK. STUDY DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Single tertiary center. METHODS: One eye was randomly allocated to the intervention, whereas the fellow eye was treated with a placebo. Eyes were operated 2 weeks apart. The participants were adults older than 20 years with refractive stability for ≥1 year, who underwent PRK for correction of myopia or myopic astigmatism. Codeine (30 mg) plus acetaminophen (500 mg) was given orally 4 times per day for 4 days after PRK. The follow-up duration was 4 months. The study outcomes included pain scores at 1 to 72 hours, as measured by the visual analog scale, McGill Pain Questionnaire, and Brief Pain Inventory, as well as adverse events and corneal wound healing. RESULTS: Of the initial 82 eyes, 80 completed the trial (40 intervention, 40 placebo). Median (interquartile range) pain scores as measured by the visual analog scale were statistically and clinically lower during treatment with codeine/acetaminophen compared with the placebo: 1 hour: 4 (2-4) versus 6 (3-6), P < 0.001; 24 hours: 4 (3-6) versus 7 (6-9), P < 0.001; 48 hours: 1 (0-2) versus 3 (2-5), P < 0.001; and 72 hours: 0 (0-0) versus 0 (0-2), P = 0.001. Virtually identical results were obtained by the McGill Pain Questionnaire and Brief Pain Inventory scales. The most common adverse events with codeine/acetaminophen were drowsiness (42%), nausea (18%), and constipation (5%). No case of delayed epithelial healing was observed in both treatment arms. CONCLUSIONS: When added to the usual care therapy, the oral combination of codeine/acetaminophen was safe and significantly superior to the placebo for pain control after PRK. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02625753.

Temperature Rises in the Pulp Chamber with Different Techniques of Orthodontic Adhesive Removal.

INTRODUCTION: The aim of this in vitro study was to compare the temperature rises in the pulp chamber and time spent with different techniques for orthodontic resin adhesive removal. METHODS AND MATERIALS: Adhesive removal was performed in 20 extracted human maxillary second premolars with five techniques: high-speed tungsten carbide burs with water-cooling (BurH-cool) and without cooling (BurH), low-speed carbide burs (BurL), low-speed aluminum-oxide discs (DiscL), and low-speed fiberglass burs (BurFGL). Pulp chamber temperature was measured with a thermocouple probe and time spent was recorded with a digital stopwatch. Comparisons of temperature rise and time between the techniques were performed with Analysis of variance and Tukey's Honestly test. Correlation between variables was investigated with Pearson's correlation coefficient. RESULTS: Temperature rise and time were statistically different between techniques and showed a positive correlation between them (r=0.826) (P<0.01). BurH-cool provoked the lowest temperature rise and BurFGL the highest (P<0.01). Temperature rises were higher with DiscL than with BurH and BurL (P<0.01), which showed no statistical differences between them (P>0.05). The fastest technique was BurH-cool followed by BurL, BurH, DiscL and BurFGL (P<0.01). CONCLUSION: BurH-cool, BurH and BurL are safe adhesive removal techniques, whereas DiscL and BurFGL may damage pulp tissues. Time spent on adhesive removal has direct effect on temperature rise in the pulp chamber.

Opioids for Ocular Pain - A Narrative Review.

BACKGROUND: Refractive surgery is a common procedure, but may be associated with severe post-operative pain. OBJECTIVES: To describe studies addressing the use of opioids for control of pain after ocular surgery, with an emphasis on refractive surgery. STUDY DESIGN: This is a narrative review of relevant articles on the physiology of corneal pain and the use of opioids for its treatment after surgery. SETTING: Single tertiary center. METHODS: A PubMed search was conducted for studies published from January 1985 to May 2015 on the physiopathology of corneal pain and opioid treatment of post-refractive surgical pain. Reviews, meta-analyses, and randomized clinical trials were included. Inclusion criteria focused on photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK). RESULTS: Authors found 109 articles through the search strategies. A total of 75 articles were included based on the inclusion criteria. DISCUSSION: Pain after ocular surgery is likely to be a multifactorial phenomenon. A combination of topical and systemic analgesics is used to treat post-operative pain after refractive surgery. Pain may be severe during the first 72 to 96 hours, depending on the surgical procedure. No studies were found that directly analyze the benefits of opioids after PRK, although they are routinely prescribed in some centers. LIMITATIONS: This is a narrative review in contrast to a systematic review and did not include studies indexed in databases other than PubMed. CONCLUSIONS: Although opioids are used for the short-term treatment of post-operative pain in refractive surgery, their benefits and risks should be properly evaluated in randomized clinical trials before their use can be safely advised. KEY WORDS: Photorefractive keratectomy, in situ keratomileusis, pain, analgesia, opioid, codeine, review.

Mechanisms of Corneal Pain and Implications for Postoperative Pain After Laser Correction of Refractive Errors.

OBJECTIVE: The cornea is the target of most surgeries for refractive disorders, as myopia. It is estimated that almost 1 million patients undergo corneal refractive surgery each year in the United States. Refractive surgery includes photorefractive keratectomy (PRK) that produces intense postoperative pain. This review presents the main pain mechanisms behind PRK-related pain and the available therapeutic options for its management. METHODS: Data sources included literature of cornea anatomy, treatment of PRK postoperative pain, mechanisms of corneal pain, in 3 electronic databases: Pubmed, Scopus, and Web of Science. Only double-blinded controlled trials on pain control after PRK were selected to show the endpoints, treatment, and control strategies. RESULTS: A total of 18 double-blind, controlled trials were identified. These studies have shown the use of topical nonsteroidal anti-inflammatory drugs, topical steroidal anti-inflammatory drugs, systemic analgesics, cold balanced saline solution, topical anesthetic, gabapentin, and morphine to treat postoperative pain in PRK. DISCUSSION: The percentage of responders has seldom been reported, and few studies allow for the formal calculation of the number necessary to treat. Postoperative intense pain after PRK laser surgery remains the main challenge to its widespread use for the correction of refractive errors.

Advances in femtosecond laser technology.

Femtosecond laser technology has become widely adopted by ophthalmic surgeons. The purpose of this study is to discuss applications and advantages of femtosecond lasers over traditional manual techniques, and related unique complications in cataract surgery and corneal refractive surgical procedures, including: LASIK flap creation, intracorneal ring segment implantation, presbyopic treatments, keratoplasty, astigmatic keratotomy, and intrastromal lenticule procedures.

Predictors of Early Postoperative Pain After Photorefractive Keratectomy.

PURPOSE: To compare the profiles of postoperative photorefractive keratectomy (PRK) pain between both eyes under the same conditions and to verify the preoperative predictors of pain such as gender, anxiety, knowledge of the procedure, and spherical equivalent refractive error (SERE). METHODS: This prospective study included 86 eyes of 43 patients with myopia who underwent PRK in both eyes at an interval of 14 days between the procedures. Before surgery, subjects answered the State Anxiety Inventory. After surgery, usual PRK pain treatment was given. Subjects answered the Visual Analog Scale, the Brief Pain Inventory (BPI), and the McGill Pain Questionnaire at 1, 24, 48, 72, and 96 hours after surgery. Pain scores and anxiety were compared between each eye using the Wald test and paired Student t test, respectively. The Wald test was performed for gender and SERE for each eye separately. RESULTS: There were no statistically significant differences between both eyes for all time points regarding the Visual Analog Scale, BPI, and McGill Pain Questionnaire-Pain Rating Index pain scores. Subjects were less anxious on average before the second surgery compared with before the first surgery (P < 0.001); however, it was not related to pain ratings after surgery. Gender did not significantly affect any scale of pain, and the SERE between -3 diopters (D) and -5 D (P = 0.035) revealed effects on the BPI. CONCLUSIONS: The profiles of postoperative pain after PRK were similar between both eyes under the same conditions. In this study, a high SERE was the only predictor for increased pain after PRK.

Femtosecond Laser-Assisted LASIK Flap Complications.

PURPOSE: To discuss intraoperative and postoperative femtosecond laser-assisted LASIK flap complications and their management. METHODS: Review of published literature. RESULTS: Flap creation is a critical step in LASIK. The femtosecond laser has improved the overall predictability and safety of the lamellar incision, but complications can still occur during or after flap creation. Although many complications (eg, epithelial ingrowth and flap striae) were reduced with the femtosecond laser application, other specific complications have emerged, such as vertical gas breakthrough, opaque bubble layer, and transient light-sensitivity syndrome. CONCLUSIONS: The application of femtosecond laser technology to LASIK flap creation has increased greatly since its introduction. These lasers have improved the safety and predictability of the lamellar incision step. The majority of the femtosecond laser-assisted flap complications can be well managed without significant effects on refractive outcomes.

Improved Evaluation of Postoperative Pain After Photorefractive Keratectomy.

PURPOSE: Postoperative pain remains an important limiting factor to the selection of photorefractive keratectomy (PRK). There is a consensus in neurology pain research that pain should be evaluated as a multidimensional concept, which differs from current practice in ophthalmology. The purpose of this paper was to validate the use of multidimensional questionnaires, such as the Brief Pain Inventory (BPI) and the McGill Pain Questionnaire (MPQ), to provide an improved analysis of pain after PRK and to better describe its temporal profile. METHODS: This prospective study included 43 eyes of 43 myopic patients who underwent unilateral PRK. After surgery, usual pain treatment was administered. All of the participants responded to the Visual Analogue Scale (VAS), the BPI and the MPQ 1, 24, 48, 72, and 96 hours after surgery. The internal consistency was evaluated, different postoperative periods were compared, and convergent validity was assessed using correlation testing. RESULTS: The Cronbach alpha test showed high internal consistency for each of the questionnaire subscales. Patients reported higher postoperative pain values at the first measurement of the VAS (4.93 ± 2.38), MPQ-pain rating index (26.95 ± 10.58), BPI-pain severity index (14.53 ± 7.36), and BPI-pain interference index (22.30 ± 15.13). Almost all of the scales and subscales showed a statistically significant direct correlation with the VAS at all of the evaluation periods. CONCLUSIONS: This study validated the utility of multidimensional questionnaires to expand the assessment of the PRK postoperative pain profile, including intensity and other qualitative aspects.

Crosslinking: an updated and effective insight / Cross-linking: uma visão objetiva e atualizada

The corneal cross-linking has been used in order to reduce and stabilize the progression of ectatic diseases through its effects on the biomechanics of the cornea. Different protocols are being conducted worldwide to expand its indications as well as its use at different ages, different stages of the disease, combinations with other techniques, besides the utilization for non-ectatic diseases. There is still no consensus on the indications of the cross-linking procedure, but the results published in the literature show significant changes in the properties of the corneal tissue. The aim of this study is to review some of these protocols already published and discuss their results, indications and complications.

O cross-linking corneano é utilizado com o objetivo de reduzir e estabilizar a progressão das patologias ectásicas através de seus efeitos na biomecânica da córnea. Diferentes protocolos estão sendo realizados pelo mundo para expandir suas indicações, assim como seu uso em diversas faixas etárias, diferentes estágios da doença, combinações com outras técnicas, além de utilizações para doenças não ectásicas. Não há ainda um consenso nas indicações do procedimento de cross-linking, mas os resultados publicados na literatura evidenciam mudanças significativas nas propriedades do tecido corneano. O objetivo desse estudo é revisar alguns desses protocolos já publicados e discutir seus resultados, indicações e complicações.

Health technology assessment to improve the medical equipment life cycle management.

Health technology assessment (HTA) is a tool to support decision making that is intended to assist healthcare managers in their strategic decisions. The use of HTA as a tool for clinical engineering is especially relevant in the domain of the medical equipment once it could improve the performance of the medical equipment. It would be done by their systematically evaluation in several aspects, in their life cycle. In Brazil, the Institute of Biomedical Engineering (IEB-UFSC) through the clinical engineering area has been working on the development of methodologies and improvements on HTA for medical equipment. Therefore, this paper presents the effort to create specific methodologies that will improve the dissemination of HTA, focusing on incorporation and utilization phase of the medical equipment life cycle. This will give a better support to the decision makers in the management of the health care system.

Classificação etiopatogênica de olheiras e preenchimento com ácido hialurônico: descrição de uma nova técnica usando cânula / Etiopathogenic classification of infraorbital dark circles and filling with hyaluronic acid: description of a new technique using a cannula

Introdução: O processo de envelhecimento na região infraorbital envolve a perda de volume, mudanças gravitacionais, e alterações de pele. Objetivo: Apresentar a classificação etiopatogênica e tratamento de olheiras causadas por mudanças no contorno da pálpebra inferior. Métodos: Uma nova técnica de preenchimento com ácido hialurónico é apresentada usando cânula romba através de um único orifício. Resultados: A reformulação da classificação das olheiras é útil para a decisão sobre a melhor opção terapêutica. A técnica descrita utilizando cânula com ponta romba se revelou segura e com bons resultados estéticos. Conclusão: O preenchimento com ácido hialurônico empregando esta nova técnica provou ser seguro, em comparação com outras pré-existentes.

Introduction: The aging process in the infraorbital region involves a loss of volume, gravitational and skin changes.Objective: To describe the etiopathogenic classification and treatment of dark circles caused by lower eyelid contour changes.Methods: A new technique of hyaluronic acid filling, using a blunt cannula through a unique orifice is presented.Results: Reformulating the dark circles classification is useful for making the best therapeutic options. The technique's advantages are its safety and good aesthetic results.Conclusion: Filling with hyaluronic acid using this new technique has proven safer than other pre-existing techniques.